We propose to establish an estimate for the prevalence of FASD in a large, diverse and multicultural U.S. urban setting - San Diego, California. Through an established collaboration with the San Diego Unified School District, the San Diego Regional Center for Developmental Disabilities, and the San Diego County Child Welfare Agency, we will employ methods that will specifically address the major barriers to developing accurate prevalence estimates including reliable and valid evaluation of physical characteristics in an age range when features are most easily recognizable, comprehensive assessment of neurobehavioral performance in children just entering school-age, and detailed information on prenatal alcohol exposure. We will establish a prevalence estimate of FASD including FAS, Partial FAS and ARND in the City of San Diego metropolitan area among a cross-sectional sample of children in the first grade age range in elementary school (5-7 years of age) and those children in the same age range and geographic area receiving special services for developmental disabilities or child welfare services. In addition, we will determine risk factors for FASD in this population, enhance capacity to make valid and reliable diagnoses of FASD by training new expert diagnosticians and through the use of 3D facial imaging, and promote study recruitment and retention through the implementation of an evidence-based intervention among children identified with FASD. We will assess participation bias among parents and caregivers in the school sample to determine if there is evidence of differential recruitment among those with higher levels of prenatal alcohol use. We also propose to host the Data Access and Coordinating Center for all projects included in the CoFASP consortium through the San Diego Supercomputer Center at the University of California, San Diego. PUBLIC HEALTH RELEVANCE: Accurate estimates of the incidence and prevalence of FASD in the U.S. are lacking. The prevalence of FASD is thought to be under-estimated due to a number of factors that will be addressed in the proposed study. Establishing accurate estimates of the prevalence of FASD in representative regions of the U.S. population is critical in order to develop a better understanding of the public health impact of this disorder as well as the potential benefits of successful prevention.